In order to support improvements in both healthcare delivery and payment systems, individuals and organizations that purchase healthcare services need a clear business case showing that the proposed change in care will achieve sufficient benefits to justify whatever change in payment healthcare providers need to support the change in care. Healthcare providers also need a clear business case showing that they will be able to successfully deliver high-quality care in a financially sustainable way.
Objective: To examine changes in patient experience across key domains of the patient-centered medical home (PCMH) following practice transformation with Lean quality improvement methodology inclusive of payment reform.
Executive Summary
The Accountable Care Collaborative completed its second year of operations in June 2013. Program results continue to be positive in terms of enrollment, cost savings, quality of care, client outcomes, and utilization of services.
Analysis of the program’s performance demonstrates:
Since 2006, a majority of states have implemented medical home initiatives in their Medicaid and Children’s Health Insurance Programs as a means of containing cost, improving health outcomes, and increasing both patient and provider satisfaction. A medical home is designed to provide team-based care—led by a primary care provider—that is comprehensive, patient-centric, coordinated, assessable, and committed to quality and safety. Many national health plans, including WellPoint, Aetna, Humana, UnitedHealth Group, and Blue Cross Blue Shield, have also embraced the patientcentered medical home
Around the country, models are emerging to link primary care providers not only to other medical service providers but also to resources and services in the community. This report—the first in a series supported by The Commonwealth Fund to explore opportunities for improvement in federal and state policy--highlights relevant policy levers and federal and state initiatives to integrate these resources.
This summary provides an overview of evidence and results from medical home demonstrations taking place throughout the United States. The results are listed in two categories:
(1) Costs & Utilization Rates: includes impact on hospital admissions and readmissions, avoidable emergency department visits, length of stay, specialist visits, in-person visits, and any impact on health care costs; and
